Pass the (iodised) salt, please

The central government's decision to reintroduce the ban on non-iodised salt raised a controversy. For a lay person, it is difficult to see which side makes more sense  the one taken by protagonists of the ban, who include India's topmost experts on iodine deficiency, or that of the opponents.
Darryl D'Monte
looks into the arguments.

There is hardly anything more emotive when it comes to food in this country than salt  also referred to as the 'common' or 'table' variety. It has strong resonances with the Dandi March, the 75th anniversary of which was celebrated with fanfare recently. From time immemorial, salt is on the one commodity that remote communities  in hill tracts as much as adivasi settlements in thickly forested regions  have bartered with their produce, since it is not locally available everywhere.

The central government's decision to reintroduce the ban on non-iodised salt from August 15 raised a controversy which may only escalate in the next few weeks. The gazette notification reads: 'Restriction on sale of common salt: No person shall sell or offer or expose for sale or have in his premises for the purpose of sale, the common salt for direct human consumption unless the same is iodised.' The ban will be enforced by the Food and Drug Administration, so it will penalise any shopkeeper who stocks non-iodised salt.

For a lay person, it is difficult to see which side makes more sense  the one taken by protagonists of the ban, who include Indias topmost experts on iodine deficiency, or that of the opponents.

Iodine is the Greek word for violet and was first isolated as a chemical for making gunpowder. The science of iodised salt appears innocuous enough. The absence of iodine in diet gives rise, in the most extreme cases, to the dreaded disease known as goitre, which is marked by swelling of the glands in the neck. In less severe cases of deficiency, it leads to cretinism and neurological disorders, which are very prevalent among the poorer population. There are several million people in India who are iodine deficient. The problem is acute in the sub-Himalayan tracts where the iodine is leached out of the soil through erosion, over millennia.

However, the problems relating to this deficiency are more widespread than is imagined. Two researchers from the Centre for Development Studies in Kerala have found traces of deficiency in Kerala schoolchildren, which clearly negated the charge that this problem is restricted to the sub-Himalayan belt.

A government survey also shows that 254 out of the 312 endemic districts in the country were deficient in iodine. Also, the WHO, UNICEF and the International Council for Control of Iodine Deficiency Disorders (IDDs) have recommended that assessing the goitre rate in school children between six and 12 years old helps estimating the prevalence of goitre in that community.

Dr Jagmeet Madan, Reader in nutrition at SNDT Womens University in Mumbai told India Together that she had conducted a study of pregnant women in the city who had displayed symptoms traceable to iodine deficiency, though not easily visible like patients are when chronically affected by goitre. A survey by the All India Institute of Medical Sciences (AIIMS) of pregnant women has shown that iodine deficiency is the major cause of mental retardation of the newborn child.

Nearly 100 countries have banned non-iodised salt, since the addition of iodine to this everyday item in ones diet appears to be the most effective way of combating the deficiency, according to goitre experts from AIIMS. New Zealand has reported disturbing increases in iodine deficiency in its population, due to the current food fad of consuming rock or sea salt and the absence of iodine in many dairy products, which are the staple of that country.

The previous ban in India was revoked in 2000 by the BJP-led government. The government had then conceded to the demands of the RSS-backed Swadeshi Jagran Manch, which championed the cause of the 8,000-odd traditional salt harvesters in Gujarat. It helped that L K Advanis constituency was Gandhinagar, in that state. In 1993, as president of the Hind Mazdoor Kisan Panchayat, one of the biggest trade unions with a membership of more than one million, George Fernandes led an agitation against the multinational Cargill, which had been given the right to produce salt in Gujarat with advanced technology. It was feared that eventually 250,000 workers would lose their jobs to mechanization. Cargill eventually beat a retreat.

According to the Salt Commissioner in Jaipur, however, the livelihoods of these traditional harvesters will not be affected because it is not as if they sell their produce directly to consumers. They market it to wholesalers who in turn sell it to producers who will now make only iodised salt.

But opponents of forced iodisation also raise medical questions. They quote Martindale in The Extra Pharmacopoeia, 1977, on the toxic effects: "Continued administration of iodine is known to lead to mental depression, nervousness, insomnia, impotence, myxoedema and goitre. Hypersensitivity to iodine (Iodism) may occur acutely or after prolonged administration Vomiting, metallic taste in the mouth, abdominal pain and diarrhoea are also known to occur. In extreme cases, death (is) also recorded. Iodides in breast milk are suspected to cause hypothyroidism or goitre in infants."
However, there is no danger of excess iodine when consumed in everyday salt, because it is not only present in such minute quantities but is diluted several-fold when used in cooking or added to prepared food.

World-renowned experts in goitre like Drs Madhu Karmarkar and C S Pandav from AIIMS, in a detailed 1997 study, asserted that the estimated population at risk for IDDs in India was 270 million people. Their assessment was that 70 million are already affected by IDDs, an estimated 2.2 million by cretinism and 6.6 million with mild neurological disorders.
"In the National Capital Territory of Delhi, prevalence of goitre was 55% in 1979 as reported by Pandav and others and 37% in 1981 The latest study carried out in 1994 after universal introduction of iodised salt in 1989, reported an overall goitre prevalence of 19.7% among the school children of Delhi," say Drs Karmarkar and Pandav. The incidence of IDDs -- as opposed to the most severe form, goitre -- is far greater than is imagined and widespread in the country: even a fifth of schoolchildren suffered it in 1994 in Delhi.
This is why nearly 100 countries have made iodised salt compulsory.

Anbumani Ramadoss, the current Health & Family Welfare Minister in the central government, has produced alarming figures to show that the proportion of the population which receives the required intake of iodine has dropped from half in 1999 to just 37% by 2003, due to the revocation of the ban.

Still, opponents of iodised salt in India say that it would be far better to create awareness that milling and polishing of rice and other grains removes their iodine content. They point out that cereals, millets, pulses, dals, leafy vegetables, roots and spices, jaggery, nuts, fruits, milk and milk products, eggs, fish and even tap water contain iodine in its natural, absorbable form. "So basically, what you need to advocate is a healthy, balanced diet and clean drinking water -- as it is worms and drinking water polluted with animal and human excreta and water rich in calcium, (drawn from deep wells ) that leads to iodine deficiency," says Digant Oza from the Janseva Trust in Ahmedabad.

The opponents also say that The National Institute of Nutrition, Hyderabad, Government of India, has excellent studies on iodine content of different foodstuffs, loss of iodine in grain milling and even iodine content of regional diets. According to them, diets in Andhra Pradesh, Gujarat, Karnataka, Kerala, Madhya Pradesh, Maharashtra, Orissa, Tamilnadu, Uttar Pradesh and West Bengal already have higher iodine content than the minimum required.

AIIMS experts acknowledge that the present concern regarding iodisation has been the reported increase in thyrotoxicosis in the population. The disease occurs when the thyroid gland releases too many hormones over a
period and is marked by Grave's disease (nervousness or over-stimulation), non-cancerous growths of glands
or tumours of the testes or ovaries. Thyrotoxicosis is linked to excess consumption of iodine and was initially reported in Tasmania in 1970, but more recently in Zaire and Zimbabwe. But experts point out that thyrotoxicosis is more likely to afflict people "when large doses of iodine are given over a short period of time to the older age group living in an iodine-deficient area for many years." Still, they admit that occasionally cases have been reported in subjects less than 45 years of age. But with the correction of iodine deficiency in the population and on-going monitoring, over a period of time people in that community are no longer prone to developing thyrotoxicosis as a result of iodine supplementation, they say.

The other concern with the government ban, which is far less clear, is one of the consumers' right to choose. The Mumbai-based Right To Know activist, Shailesh Gandhi says that Indian citizens are free to smoke and eat tobacco, and even Gutka which has been certified carcinogenic; they may drink bottled water or cold drinks having pesticides, eat foodgrains with excessive pesticides, but may not eat the salt of the earth. "The Government of India is going to ban the sale of non-iodised salt by amending the Prevention of Food Adulteration Act. It is beyond comprehension as to how common salt is going to be classified 'adulterated', if iodine is not added to it!" he adds.

Gandhi feels that common salt, which mankind has partaken of from time immemorial, must not be banned. The Government has been advised that iodine-deficiency is a major problem in India, and hence citizens must be refused access to salt unless it has iodine added to it. "For the poorest in the land, this translates into an extra burden They can do this only by reducing expenditure on their presently inadequate food intake," he says, bringing in the cost factor.

The cost of iodised salt is higher because of the iodine input itself along with the iodisation process, packaging, marketing, distribution and monitoring of iodisation. But even according to Gandhi, "The price of ordinary salt is about Rs 2 to Rs 3 per kg., whereas the price of iodised salt is about Rs 7 per kg. At a price difference of Rs 4 per kg. and an assumption of an average family of four people consuming 1.5 kg., per month, the per head the cost addition is Rs 1.50 per month, or Rs. 18 per year per person." This would seem a reasonable cost to incur to ward off IDDs.

But Gandhi takes his argument against the ban further, saying that the state may next be advised that a lot of Indians are vitamin-deficient and therefore the sale of wheat must be banned; only wheat flour fortified by vitamins may be sold. "The basic issue is one of freedom of citizens. The state has perhaps unwittingly chosen the potently symbolic salt to challenge this freedom," he says. This argument against the ban sounds quite reasonable, since a ban has not been placed on tobacco, alcohol and many other harmful products.
However, there is a difference: people suffer from iodine deficiency without knowing about it, surely there is a constitutional role for the state to safeguard the health of the people.

Darryl D'Monte22 August 2005

Darryl D'Monte, former Resident Editor of The Times of India in Mumbai, is Chairperson of the Forum of Environmental Journalists of India and founder President of the International Federation of Environmental Journalists.

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